Provider Demographics
NPI:1164454567
Name:KRAY, RYAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAVID
Last Name:KRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:811 2ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3559
Mailing Address - Country:US
Mailing Address - Phone:320-631-7231
Mailing Address - Fax:320-632-0534
Practice Address - Street 1:811 2ND ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3559
Practice Address - Country:US
Practice Address - Phone:320-631-7231
Practice Address - Fax:320-632-0534
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
992494OtherAMERICA'S PPO
0104531OtherMEDICA
MNA022OtherTRICARE
MN688519500Medicaid
MN125283C736OtherUCARE MINNESOTA
MN18F29KROtherBCBS OF MINNESOTA
HP30404OtherHEALTH PARTNERS
NA9231025171OtherPREFERRED ONE
NA9231025171OtherPREFERRED ONE
MN080008901Medicare ID - Type Unspecified
MN688519500Medicaid